Specific Components of Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement

Abstract

Objective The development of attention-deficit/hyperactivity disorder (ADHD) care quality measures is a prerequisite to improving the quality of community-based pediatric care of children with ADHD. Unfortunately, the evidence base for existing ADHD care quality metrics is poor. The objective of this study was to identify which components of ADHD care best predict patient outcomes. Method Parents of 372 medication-naïve children in grades 1-5 presenting to their community-based pediatrician (n = 195) for an ADHD-related concern and who were subsequently prescribed ADHD medication were identified. Parents completed the Vanderbilt ADHD Parent Rating Scale (VAPRS) at the time ADHD was raised as a concern and again approximately 12 months after starting ADHD medication. Each patient's chart was reviewed to measure twelve different components of ADHD care. Results Across all children, the mean (SD) VAPRS Total Symptom Score (TSS) reduction over the first year of treatment was 11.6 (10.1). Of the twelve components of ADHD care, shorter times to first contact and more teacher ratings collected in the first year of treatment significantly predicted greater reductions in patient TSS scores. Notably, it was timeliness of contacts, defined as either office visits, phone calls, or email communication, that predicted more ADHD symptom reduction. Office visits alone, in terms of number or timeliness, did not predict patient outcomes. Conclusion The magnitude of ADHD symptom reduction that can be achieved with the use of ADHD medications was associated with specific components of ADHD care. Future development/modifications of ADHD quality care metrics should include these ADHD care components.

Effects of Collaborative Care for Comorbid Attention Deficit Hyperactivity Disorder Among Children With Behavior Problems in Pediatric Primary Care

“…These findings add to the large body of evidence documenting significant improvements in parent-and teacher-reported ADHD symptoms after comprehensive training or quality improvement programs for children with ADHD in community pediatric practices. 19,20,[23][24][25][26][27] In addition, DOCC cases showed a greater improvement in ODD symptoms and individualized ODD treatment targets, better quality of life, and greater overall functional improvement. Such gains in comorbid clinical symptoms and healthier functioning are worth noting given that broader clinical improvements are not always found and may vary based on the level of exposure to other psychosocial interventions.…”

“…Such gains in comorbid clinical symptoms and healthier functioning are worth noting given that broader clinical improvements are not always found and may vary based on the level of exposure to other psychosocial interventions. 24,25 In DOCC, virtually all caregivers and children received at least some psychosocial intervention.…”

“…A second trial found that a quality improvement intervention using these and other methods enhanced specific components of medication care (eg, days to first contact after medication, number of teacher scales collected) relative to controls, which were also related to lower ADHD symptom scores. 24 Two uncontrolled quality improvement studies by the same team 25,26 examined an expanded collaborative intervention (eg, training, office flow management, scripts for assessing response, patient report cards). The intervention showed gains in PCPs’ use of rating scales and monitoring of medication response, 23 use of titration, and follow-ups during medication management.…”

“…Furthermore, it is important to include medication prescription or utilization data based on the medical record and long-term outcome data in order to understand if medication use or continuity is related to clinical improvement. 24 To further document improvement in ADHD- and oppositional defiant disorder (ODD)-related outcomes, we examine a novel outcome measure that captured individualized treatment targets related to a child’s ADHD or ODD and progress toward reaching these goals, 32 pediatric quality of life, and overall clinical global functioning. Finally, some studies have reported small samples, significant reductions in sample size across time, or the lack of an experimental design, which may raise questions about the representativeness of the sample on which final analyses are based.…”

Comparison of Attention‐Deficit/Hyperactivity Disorder Care Between School‐Based Health Centers and a Continuity Clinic

“…Adherence to the AAP guidelines produces better ADHD outcomes. A short time from medication initiation to physician contact and consistent receipt of structured reports from teachers in the first year of treatment have been shown to predict greater decreases in patient total symptom scores . Additionally, use of a validated, structured report from a teacher is more reliable at assessing symptom severity at school than relying solely on the Vanderbilt submitted by the parent …”